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Volumetric or time-based capnography for excluding pulmonary embolism in outpatients?

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Verschuren, Franck [UCL] Sanchez, O Righini, M Heinonen, E Le Gal, G Thys, Frédéric [UCL]

Summary. Background: Volumetric capnography is technically more demanding but theoretically more performant than the time-based alveolar deadspace fraction (PaCO(2)-EtCO(2))/PaCO(2) as bedside diagnostic tool for ruling-out pulmonary embolism (PE) in outpatients. Objective: We compared both diagnostic accuracies, combined to clinical probability evaluation, in patients with a suspicion of PE and positive ELISA D-dimer results. Patients and methods: In this clinical multicenter trial with prospective inclusion and three-month follow-up, alveolar deadspace fraction was compared by ROC analysis with other parameters derived from volumetric capnography. Results: Capnography was performed in 239 patients, of which 205 tests (86%) were conclusive. The prevalence of PE was 33%. The ROC curve analysis for alveolar deadspace fraction was 0.73+/-0.04. The diagnostic performances of parameters from volumetric capnography were not significantly better. 16% (95% CI 12%-21%) of patients presented a (PaCO(2)-EtCO(2))/PaCO(2) ratio under the cut-off value of 0.15 with a low clinical probability. This combination excluded PE with a sensitivity of 96% (95% CI 89%-99%) and a negative likelihood ratio of 0.17 (95% CI 0.09-0.33). Conclusion: Volumetric capnography failed to achieve better performances than the alveolar deadspace fraction (PaCO2-EtCO2)/PaCO2 for excluding PE in outpatients with positive D-dimers. Future studies should clarify the safety of ruling out PE in patients combining a low clinical probability with positive D-dimers and a (PaCO2-EtCO2)/PaCO2 ratio under the cut-off value of 0.15.

Document type Article de périodique (Journal article) – Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
Publication date 2009
Journal information "Journal of thrombosis and haemostasis : JTH" - Vol. 8, no. 1, p. 60-7 (2010)
Peer reviewed yes
issn 1538-7933
e-issn 1538-7836
Publication status Publié
Affiliations UCL - SSS/IREC/MEDA - Pôle de médecine aiguë
UCL - (SLuc) Service des urgences
MESH Subject Time Factors ; Sensitivity and Specificity ; Respiratory Dead Space ; ROC Curve ; Pulmonary Embolism - blood - diagnosis - metabolism ; Prospective Studies ; Predictive Value of Tests ; Point-of-Care Systems ; Outpatients ; Middle Aged ; Likelihood Functions ; Humans ; Fibrin Fibrinogen Degradation Products - metabolism ; Europe ; Enzyme-Linked Immunosorbent Assay ; Carbon Dioxide - metabolism ; Capnography ; Aged, 80 and over ; Aged
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Bibliographic reference Verschuren, Franck ; Sanchez, O ; Righini, M ; Heinonen, E ; Le Gal, G ; et. al. Volumetric or time-based capnography for excluding pulmonary embolism in outpatients?. In: Journal of thrombosis and haemostasis : JTH, Vol. 8, no. 1, p. 60-7 (2010)
Permanent URL http://hdl.handle.net/2078.1/28492